WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.WHO has recognized the importance of water and sanitation from its inception.

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A new study published on 18 September 2013 provides early evidence that adverse events due to medical care represent a major source of morbidity and mortality globally and reinforces the important role quality and safety of care plays in global health. The study, "The Global Burden of Unsafe Medical Care: An Observational Study", published today at the BMJ Quality & Safety, describes the main results of a first-ever study commissioned by the World Health Organization (WHO) and led by Dr Ashish Jha and David Bates, patient safety scientists of the Harvard School of Public Health and the Brigham & Women’s Hospital respectively.

Adapting the methodology developed for the Burden of Disease study series, the researchers estimated disability-adjusted life years (DALYs) lost to measure morbidity and mortality due to specific adverse events. Available data were found for the following set of adverse events: (i) adverse drug events, (ii) catheter-related urinary tract infections, (iii) catheter-related blood stream infections, (iv) nosocomial pneumonia, (v) venous thrombo-embolisms, (vi) falls and (vii) decubitus (pressure) ulcers. The study estimates that there are 421 million hospitalizations in the world annually and approximately 42.7 million adverse events for the seven types described, resulting in 23 million DALYs lost per year. Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in low and middle income countries. It is clear that this is an early attempt to quantify the burden of unsafe care and more analysis is needed to understand sources of imprecision in these estimates. That said, these data show that the problem of unsafe health care is significantly greater than previously thought globally and that global health policymakers should consider how to make safe patient care an international priority.

“WHO undertook the challenge of estimating the global burden of unsafe care as an essential step to guide global actions in strengthening health systems,” Says Sir Liam Donaldson, WHO Envoy for Patient Safety. “These data are a powerful signal to strengthen the performance of healthcare and to remind policy makers and professionals alike that, to achieve improvements in global health, effective investments to measure and improve the safety of the healthcare are most needed”.

The number of DALYs lost were more than twice as high in low- and middle- income countries (15.5 million) as they were in high income countries (7.2 million). Compared to other conditions, the combination of these seven types of unsafe care alone ranks as the 20th leading cause of morbidity and mortality for the world’s population. It is unlikely that these are “new” previously undiscovered DALYs, but rather that they are captured within the injuries and deaths attributed to other conditions such as cardiovascular disease.

“This study highlights that the standards for safety and quality that patients experience within the healthcare systems across the world, and especially in low-income countries, have a direct impact on their health status and wellbeing,” says Dr Marie-Paule Kieny, WHO Assistant Director General for Health Systems Strengthening and Innovation. “It is therefore essential to set effective mechanisms to reinforce and strengthen the conditions for healthcare delivery to lead to improvements in the safety and quality of care, and therefore to achieve effective universal health coverage”. Unsafe medical care may even lead patients to opt out of using the formal healthcare system, raising questions of appropriateness and quality of care in the informal sector. In this sense, unsafe care becomes a potentially significant barrier to access for many of the world’s poor.

This study faced significant barriers due to limitations in availability and quality of data sources, hampering the ability to effectively calculate the number of DALYs lost due to unsafe care, particularly within low and middle income countries. While further refinements of the estimates are needed, the data provided in this manuscript represent a significant contribution to the understanding of the burden of unsafe care. They also signal a new direction of scientific enquiry where further methodological developments are necessary to nurture the necessary understanding of this important field.

“This landmark study is also an appeal to the donor and scientific communities to further invest and investigate in this important area of work and to creatively develop methodologies to fill the current gaps in data availability and data quality,” says Dr Edward Kelley, Coordinator of the WHO Patient Safety Programme. “Furthermore, it also calls for policy action to strengthen information systems, of which the medical record and related data sources are essential for the needed understanding about the tall of unsafe care”. The estimates provided are conservative, hindering not only the ability to calculate their consequences, but also limiting the ability of clinical leaders and policymakers to track the potential impact of policies designed to increase the safety of healthcare as well as universal health coverage. Given the magnitude of the effects shown in this manuscript, it is fair to suggest that to improve the health of the world’s citizens, actions are needed to not only improve access to care but also to invest substantial focus on improving the safety of the healthcare systems that people access worldwide. When patients are sick, they should not be further harmed by unsafe care.

WHO CONFERENCE REPORT JANUARY 18-23RD 2010 WRITTEN BY ISA WILSON CICIAMS DELEGATE

The address of the Direct-General-Dr Margaret Chan was mainly on the subject of the Haitian earthquake which had happened a few days earlier. She spoke of the massive loss of lives, the horrendous injuries experienced by many survivors and the total destrution of so many homes and buildings including the Medical and Nursing faculties within the University and the response of WHO to this disaster. She also spoke of the need of all member countries to respond to the call for help for this the poorest country in the Western hemisphere. Dr Chan went on to congratulate all those countries who cooperated with information and vaccine sharing during the pandemic outbreak of Swine Flu and the need to continue this preparedness in sharing resources in the event of further pandemic outbreaks. Many other world health issues were also highlighted in Dr Chan's address.I was fortunate to be meeting with Dr Jean Yan , Chief Nurse Scientist about CICIAMS collaboration plans, and I was invited to take part in a brainstorming session to initiate the immediate, medium and longterm nursing needs in Haiti. This included a two way link with the WHO Chief Nurse of the Caribbean Islands who was coordinating the nursing teams in Haiti.She gave an update on the situation and the immediate help needed. She informed us that although the Nursing Faculty in the University had been destroyed, the NursingCollege was operational but with little in the way of equipment such as dressings and bandages. She told us that while the staff had set up a receiving centre for the wounded many of the students were out begging for dressings and bandages in the surrounding areas.It was an uplifting and emotional experience to be part of this session and to hear from all the Heads of the Nursing and Midwifery departments at WHO what would be attempted in the immediate, medium and long term to meet the health needs of the people of Haiti. It gave me an insight into the tremendous work of WHO.I was delighted to be informed that our plans for collaboration with WHO for 2010-2012 had been approved so our status as NGO in WHO is assured until 2012 when our next submission will be due. I hope this will encourage all members to inform CICIAMS ofall the good work they are involved in so that our status in this organisation will continue for many years.

Isa Wilson-Delegate

HIV :TOWARDS UNIVERSAL ACCESS BY 2010

Since 1981 when HIV/AIDS was first described, an estimated 60 million people have been infected with HIV, of whom some 20 million have died. UNAIDS reports that, globally, less than one person in five at risk of HIV has access to basic HIV prevention services. Only 24% of people who needed HIV treatment had access to it by mid-2006. Following the commitment by G8 members and, subsequently, heads of states and governments at the 2005 UN World Summit, the UNAIDS Secretariat along with their partners, have been engaging in consultations to define the concept and a framework for universal access to HIV/AIDS prevention, treatment and care by 2010.

Bulletin of the World Health Organization 2009;87:225-230. doi: 10.2471/BLT.08.051599

Introduction

Recently, considerable attention has been focused on the apparent shortage of health workers in countries with the poorest health

indicators, and the potential impact of the shortage on countries’ ability to fight diseases and provide essential, life-saving interventions.1–3 According to recent WHO estimates, the current workforce in some of the most affected countries in sub-Saharan

Africa would need to be scaled up by as much as 140% to attain international health development targets such as those in the Millennium Declaration.4 The problem is so serious that in many instances there is simply not enough human capacity even to

absorb, deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries.

Health worker shortage in sub-Saharan Africa derives from many causes, including past investment shortfalls in pre-service training, international migration, career changes among health workers, premature retirement, morbidity and premature

mortality.5,6 Yet the dynamics of entry into and exit from the health workforce in many of these countries remain poorly understood. This limits the capacity of national governments and their international development partners to design and implement

appropriate intervention programmes. In this paper, we fill some of this information gap by providing the first systematic estimates of health worker inflow and outflow in selected sub-Saharan African countries. For reasons of data availability, our analysis is restricted to two groups of health workers – nurses and midwives combined, and

physicians – and to 12 countries for which the relevant data were available.

Methods

The analysis required information on the stock of health workers in each country, as well as annual inflows and outflows. Inflows are associated with the number of new workers hired each year, either graduates of training institutions, migrants or people reentering

the workforce. Outflows are caused by premature deaths among health workers, dismissals, resignations (e.g. to migrate or change career) and retirement. Much of this information is not available in many countries, so this study focuses on 12 African

countries where information was available on the size, age and sex distribution of the health workforce as well as on graduations from training institutions: Central African Republic, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Kenya, Liberia,

Madagascar, Rwanda, Sierra Leone, Uganda, the United Republic of Tanzania and Zambia. Baseline health worker numbers by age and sex were obtained from a WHO survey of health workers conducted in African countries in 20057. This survey is also the source of the data on health worker training institutions, including the number of trainees by type of worker and year of graduation. We use the number of graduates as the maximum possible level of new domestic graduates hired each year. No data on in-migration of health workers or on the number rejoining the workforce annually were

available for any of the countries, though we expect in-migration to be limited to those countries whose health workers are recruited by richer countries. Information on the outflow of health workers is also difficult to obtain. There are patchy data available on the mobility and mortality of health workers as distinct from the rest of the population, but they are limited in scope and rigour.8,9 Thus, we WHO | The health worker shortage in Africa: are enough physicians and nurses being trained? Page 1 of 4 http://www.who.int/bulletin/volumes/87/3/08-051599/en/print.html 2009-03-11

preferred to use age- and sex-specific mortality rates for the population as a whole, as they are usually of good quality,10 and to assume these rates also applied to health workers. These data were also used to estimate the numbers of health workers retiring

each year. In the absence of country-specific information on retirement ages in the public and private sectors, we applied an age of60 years to all settings on the assumption that all health workers who survive to that age then retire.

Data on out-migration, resignation before retirement age and dismissals were also not available for most of the countries under study. Migration data, for example, are not collected routinely by occupation in either “supplier” or recipient countries and, even

when pieces of the puzzle are available, they tend to be either incomplete or of indeterminate time scale.11–13 As a result, for the present analysis we adopted rates obtained from two separate case studies in Mozambique and Zambia that provide time-specific data on spatial and career mobility.14–16 Both studies focused on public sector health workers. In Mozambique, 2.3% of the workforce left service each year due to resignation (including for migration) or dismissal, while in Zambia only 1.5% left. Because we cannot say if these rates are typical of other countries, we report two sets of figures based on the two rates.

Finally, taking into account available information on inflows and outflows, we compared the estimated net growth rates of the health workforce to population growth rates estimated for the respective countries by the United Nations Population Division.17

This allowed us to assess two important outcomes given current trends. The first was whether the net growth rate of the health workforce is faster than that of the population, allowing health worker density to increase over time. The second was the extent to

which the workforce would need to grow in each country to attain the minimum density of 2.28 health workers per 1000 population. This was the yardstick developed and reported as being necessary to achieve desired levels of coverage of key health

interventions in the World Health Organization’s The world health report 2006.1

Results

Table 1 presents the estimates of the density of physicians per 1000 population and the annual inflows and outflows per 1000 physicians currently employed. Rates of inflow (also known as workforce regeneration rates) were obtained by dividing the annual number of medical graduates by the total stock of physicians in each country. This is a useful way to understand the proportion of the current workforce that is being regenerated each year. The rate of outflow includes all causes. As explained, premature

mortality and retirement rates are country-specific. Scenario I then adds the rate obtained from the Zambian study to calculate resignations and dismissals, while scenario II uses the higher rates observed in Mozambique. Table 2 reports the same estimates for

The results for all 12 countries combined show that, for every 1000 physicians practicing in these countries, 59 medical graduates are produced each year. The rate is slightly higher for nursing and midwifery, at 66 new graduates per 1000 practicing nurses and

midwives. The regional average, however, masks the diverse patterns in the study countries. For instance, in 9 of the 12 (the exceptions are the Democratic Republic of the Congo, Ethiopia and Sierra Leone) the rate at which new graduates enter the system is actually higher for physicians than for nurses and midwives. Moreover, countries that have a relatively high graduation rate for one type of health worker do not necessarily have a relatively high rate for the other. For example, Côte d’Ivoire has the highest graduation rate for physicians (14%) but ranks only 7th in the regeneration rate for nurses and midwives (2.7%).

Generally, in all countries outflows are slightly lower for nurses and midwives than for physicians because age-specific death rates are typically lower for women than men and the proportion of females is higher among nurses and midwives than among physicians. For the 12 countries as a whole, each year the health sector is expected to lose some 2.4% of its physicians and 2.1% of its nurses and midwives to premature mortality, and about 4–6% of both due to all causes combined. Although the 12 countries as a whole are training sufficient physicians to replace outflows when inflows and outflows are

considered together, this is not the case in at least one of the outflow scenarios for 6 countries. The situation is even worse when it comes to nurses and midwives, with only 3 countries (Ethiopia, Liberia and Sierra Leone) unequivocally training sufficient workers to replace those leaving the workforce. However, even in the countries where training is above replacement rates, it is not clear that they will soon be in a position to meet

current unmet needs or the increasing demands of an expanding population. Table 3 shows current density per 1000 population for physicians, nurses and midwives combined, with the net rates of increase (or decrease) under the two scenarios and the rate of population growth. Only 6 countries (Côte d’Ivoire, Ethiopia, Liberia, Madagascar, Sierra Leone and the United Republic of Tanzania) show net rates of increases under both scenarios. In the others, the absolute numbers of physicians, nurses and midwives

seem to be declining. This decline is even more serious when considered alongside the relatively high rates of population growth in most of these countries.

Table 3. Current density of physicians, nurses and midwives and required rate of workforce growth according to population growth rates in 12 African countries

Even among countries with positive net growth rates, only two (Côte d’Ivoire and Ethiopia) stand a chance of meeting some of the current unmet demands in the future by virtue of unequivocally having a faster-growing number of health workers than inhabitants. Nonetheless, the rate of health worker increase is much slower than that required to increase the density to the WHO target of 2.28 health workers per 1000 population in a relatively short time. The column on the right shows the rate of health workforce growth required for each country for the target to be achieved by 2015, the year set for the achievement of the United Nations’ Millennium Development Goals. Not even these 2 countries are expanding health worker supply fast enough to achieve this aim.

Discussion

Previous work on health workers in sub-Saharan Africa has focused on the numbers available and on the numbers leaving the workforce at a particular point in time.2,5,6 The results have clearly shown that the current number of health workers is insufficient

to meet population health needs at that point in time. This study, which was the first to examine whether current pre-service training can improve the situation, took into account population increases and attrition due to premature death among health

workers, retirement, resignation and dismissal. Although each of these components requires separate and careful analysis, the larger picture of workforce dynamics emerges only when they are considered together.

Training capacity insufficient

Our analyses suggest that workforce shortages in the countries under study are even more alarming than suggested by the existing literature. Not only are current numbers insufficient to meet health needs but, in at least 6 of the 12 countries, pre-service training is insufficient to maintain absolute numbers even at their current levels. Current rates of training are sufficient to increase health worker densities in the other 6 countries but, in 4 of them, not enough to keep pace with population growth. This will lead to a drop in health worker availability per person in those countries. Even the 2 countries where current rates of training will increase health worker density will not be able to meet the target level of 2.28 physicians, nurses and midwives per 1000 population until well after 2015.

Future direction

Boosting pre-service training is clearly important but is a longer-term solution because putting in place the infrastructure (human as well as physical) that is needed in these countries will take a long time. Hence, a variety of complementary, shorter-term responses must be considered. For instance, shifting some tasks from people requiring longer-term training to those requiring less intensive training will enable more services to be made available in a shorter time.18,19 Aggressive retention policies, such as improving the remuneration and working conditions of health workers, addressing unemployment, using telemedicine, and encouraging short term in-migration from surplus to deficit countries, may also be possible, perhaps with donor support.20–22 Preventing AIDS will reduce premature mortality among health workers in the longer-term, while providing antiretroviral treatment for health workers who need it will enable them to work longer. The issue of workers resigning to migrate or to change careers is also vitally important, and several international efforts are under way to address this complex issue.23 While these shorter-term options should be considered, it is important not to ignore the more expensive, longer term issue of preservice training. Only by addressing all of these facets together can solutions be found to the current health worker crisis in Africa.While considering the policy implications, it is also necessary to be aware of the limitations of the study, the most important of which is the difficulty in obtaining accurate figures for the numbers of health workers in a country. Ours come from a questionnaire sent to WHO country offices. The questionnaires were completed with the help of any official records that were available, including professional registers of members, though these might not be totally accurate or up to date. In addition, estimates of the annual number of graduates from training institutions were sometimes obtained by contacting each of the known institutions. The figures on outflows associated with reasons other than death were taken from two in-depth country studies. Data limitations also prevented us from focusing on other workers besides physicians, nurses and midwives. We acknowledge, therefore, that the estimates presented in the study might not be exact and highlight the need for more investment in collecting the basic data necessary for informed decision-making. The fact that outflow estimates for dismissal and resignation were derived from two case studies that may not be representative in themselves also calls for caution. However, to address these data problems, we have tried to make the most conservative assumptions possible. For example, we assumed that all graduates from training institutions would immediately enter the workforce. There will be some immediate loss of potential health workers at

this stage, so our estimates probably overestimate the ability of current training institutions to replenish supply. It is also important to acknowledge that with current attention being focused on health worker shortages, some of the countries under study may already have scaled up training and taken other steps to alleviate them, and this would not be captured by our figures. It is, therefore, necessary for countries to take appropriate action to promote the collection and analysis of data on entry and exit from

the health workforce. ■

Acknowledgements

Yohanes Kinfu worked at WHO at the time this research was conducted.

Competing interests: None declared.

References

1. The world health report 2006: working together for health. Geneva: World Health Organization; 2006.

From the Bulletin of the World Health Organization:The International Journal of Public Health -60th Anniversary Commemorative Volume

IT’S NOT EXPENSIVE TO PREVENT REPEATED SUICIDE ATTEMPTS

1 September 2008. GENEVA – The vast majority (85%) of deaths due to suicide occur in low and middle-income countries. While wealthy, industrialized countries provide sophisticated psychotherapeutic treatment poorer countries have little to nothing to offer those who have survived suicide attempts.

New findings published today show, however, that poor countries can considerably improve prevention of repeated attempts at suicide. Providing an information session and supportive ongoing contact to people who attempted suicide, such as telephone calls, can significantly reduce these deaths, according to the study published in theBulletin of the World Health Organization, a leading public health journal.

"People who make attempts at suicide often end up in emergency rooms. But in low to middle-income countries, if there are no complications, patients are discharged after being treated for their injuries with no referral to mental health services," says author Fleischmann.

"However, by providing the patient with information and following up with telephone calls further attempts can be prevented and lives can be saved," Fleischmann says.

The study was conducted in Brazil, China India, Islamic Republic of Iran and Sri Lanka from January 2002 to October 2005. Read the study here:

NOTICE TO READERS: The Bulletin of the World Health Organization was created by WHO as a forum for public health experts to publish their findings, express their views and engage a wider audience on critical public health issues ofthe day. Consequently, the views expressed by the writers inthese pages do not necessarily represent the views of WHO.

GENEVA -- Some 423,000 people in Pakistan need urgent health care after being affected by recent conflict and flooding. The World Health Organization (WHO) and partners are requesting US$9.76 million to undertake life-saving health responses to this humanitarian crisis.

Outbreaks of communicable diseases, including acute watery diarrhoea, respiratory infections, and various water- and vector-borne diseases, are of high risk due to large numbers of people forced into cramped, temporary housing where concerns exist over the safety of drinking water and sanitation. With malaria season starting, risks for a large-scale spread of malaria are high. Outbreaks of measles, one of the major killers of children, are also possible due to low immunization coverage in some areas.

"Thousands of lives are at risk in Pakistan if we do not act now to provide urgent health care to those affected by these terrible floods or forced from their homes by violence," said Dr Eric Laroche, Assistant Director-General for WHO's Health Action in Crises Cluster.

Pakistan's worst-hit areas by August's heavy monsoon rains were Peshawar, in the Northwest Frontier Province (NWFP), and Rajanpur, in Punjab province. Mud houses were washed away and clinics, bridges and other infrastructure destroyed. Some 200 000 people were affected in NWFP and 100,000 in Punjab. Many urgently need aid, particularly the elderly, sick and disabled.

Violence in NWFP and the neighboring FATA has forced 123,000 people to flee in recent months. While a considerable number of displaced people have returned due to the Ramadan cease-fire, it is estimated that 400,000 more could be displaced if hostilities resume at the end of Ramadan (late September) or earlier. UN agencies cannot reach a further 200 000 displaced inside FATA.

WHO and the Ministry of Health are coordinating the activities of health players as part of the "Health Cluster" response to address the health needs of people in camps and areas of return, as well as support health services in the seven districts hosting the displaced.

“Local authorities, with federal support, have provided help, including healthcare support and food,” said Dr Khalif Bile, WHO’s representative to Pakistan. “But the extent of the crisis means more aid is needed, including medicines, water and sanitation materials for 150 000 people. Restoring key services, like health, is vital.”

WHO announced a US$5.5 million package as part of the Pakistan Humanitarian Response Plan to:

For more information on this and on floods situations in Africa and Asia, please contact:Paul GarwoodCommunications OfficerHealth Action in CrisesWHO, GenevaTel.: +41 791 3462Mobile: +41 794 755546E-mail garwoodp@who.intwww.who.int/disasters

Yaoundé — Health Ministers from countries of the African Meningitis Belt today committed themselves to introduce a highly promising candidate meningitis vaccine. The vaccine is designed to prevent periodic epidemics of the deadly disease in these countries.

Meeting at the World Health Organization's 58th Regional Committee for Africa held in Yaoundé from 1-5 September, Ministers adopted the Yaoundé Declaration, committing themselves to several actions. Notably, they agreed to prepare comprehensive meningitis control plans, including the introduction of the new vaccine, once available; to implement meningitis control strategies; to undertake joint action vis-à-vis the threat; to improve information exchange for epidemic response and to contribute financially to activities to control epidemics.

"Several hundred million persons are at risk of meningitis in 25 African countries. Many generations have suffered," said Professor Avocksouma Djona, Minister of Public Health, Chad. "On behalf of all affected countries in Africa, today we are collectively committing ourselves to put an end to devastating outbreaks of this disease. We will ensure that this effective new vaccine is made available to populations throughout the Meningitis Belt," he said.

"The new vaccine is the result of a deliberate effort to get ahead of these epidemics, at a price affordable in Africa. With this vaccine, countries can move away from a reactive response to emergencies towards elimination of the epidemic threat," said Dr Margaret Chan, Director-General, WHO. She added that WHO will provide technical support for introduction of the vaccine.

The candidate vaccine has several advantages. Priced at just US$ 0.40 per dose, the vaccine produces in both adults and toddlers a higher immune response than the currently available vaccine. In addition, the new vaccine confers long-term protection and induces immunity in certain non-vaccinated persons who live in proximity of those who are immunized, leading to broad community protection.

The meningitis prevention and control strategy that affected countries will implement entails introducing the new meningococcal A conjugate vaccine to immunize a population of approximately 250 million 1 to 29 year-olds and 23 million infants living in 25 African countries from 2009-10 to 2015. It also requires ensuring that adequate quantities of the currently available meningococcal polysaccharide vaccines are available for epidemic response. The latter initiative is important for two reasons: first, to ensure a smooth transition from current epidemic response strategies to a preventive approach and, second, to respond to the threat of non-group A meningococcus meningitis outbreaks (group C or W135).

The meningitis prevention and control strategy was reviewed and endorsed by WHO's Strategic Advisory Group of Experts on Immunization in April 2008, and by the GAVI Alliance Board in June 2008.

"Vaccination with the new meningitis vaccine is money well spent. Our initial investment of US$ 55 million towards a meningitis stockpile will greatly help stave off additional outbreaks of this disease," said Dr Julian Lob-Leyvt, Executive Secretary, GAVI Alliance. The GAVI Alliance is a public-private partnership of major stakeholders in immunization including WHO, UNICEF, the World Bank, developing country and donor governments, the vaccine industry research and technical agencies, civil society and the Bill & Melinda Gates Foundation.

The new product, conjugate meningococcal A vaccine ("MenAfriVac"), was developed through the Meningitis Vaccine Project a product development partnership between WHO and the Program for Appropriate Technology in Health (PATH), a non-governmental organization. The Project was set up in 2001 with core funding from the Bill & Melinda Gates Foundation.

"A single case of meningitis can drive a family into a spiral of poverty from which they may never recover. By committing to introducing MenAfriVac in meningitis belt countries, African governments will play a pivotal role in eliminating epidemics that have plagued the continent for more than a century, and they will help reduce poverty," said Dr F. Marc LaForce, Meningitis Vaccine Project Director.

"Meningitis outbreaks have devastated communities in the poorest countries of Africa for many years. Children, in particular, are at risk. Now, with the new vaccine that is promising to be effective longer, there is a good chance that we can finally get a grip on the disease and protect all children and parents from this life-threatening disease," said Esther Guluma, Regional Director, UNICEF Regional Office for West and Central Africa.

"This is a major development in the prevention and control of cerebro-spinal meningitis in the Sahel countries that will reduce the risk of epidemics currently killing thousands of people in the meningitis belt," said Dr Luis Gomes Sambo, Director, WHO Regional Office for Africa.

The new vaccine is expected to be introduced starting in 2009-10 in Burkina Faso and will be phased into an additional 24 countries between 2010 and 2015, with GAVI support. GAVI funding will also go towards ensuring sufficient stocks of the current vaccine are available for epidemic response during the introduction of MenAfriVac.

Background

The candidate conjugate meningococcal A vaccine protects against infection by group ANeisseria meningitidis (meningococcus), the strain mainly responsible for deadly outbreaks in 25 "meningitis belt" countries. Some 430 million people, living in the area stretching east to west across the continent from Senegal to Ethiopia are at risk of this bacterial disease. Even with antibiotic treatment, at least 10% of patients die and up to 20% have serious permanent health problems as a result of the disease.

A Phase I clinical trial in adults aged 18 to 35 years was successfully completed in India. Phase II clinical trials of the candidate vaccine have been completed in The Gambia and Mali and showed almost 20 times higher antibody levels in one to two year olds, compared to the existing polysaccharide vaccine. (Follow-up of this trial is ongoing). Phase II/III clinical trials have been successfully completed in two to 29 year olds in The Gambia, Mali and Senegal.

The vaccine is safe in testing and is manufactured by an Indian company.

Next steps

An additional large phase III trial will be conducted in India and Mali in early 2009. A phase II study in infants began in Ghana in late August with results expected in 2010. The results of these trials may allow to extend indications for use to infants.

The vaccine is expected to be licensed in India in the course of early 2009, and to be submitted for WHO evaluation shortly thereafter. African countries may also register the vaccine during 2009 to allow early introduction.

LIBREVILLE, GABON, 29 August 2008 -- Health and Environment Ministers in Africa have resolved to build a strategic health and environment alliance to reduce environmental threats to human health and well-being.

Following the conclusion of an historic gathering in Gabon, the ministers signed and adopted the Libreville Declaration which commits governments to take the required measures to stimulate the necessary policy, institutional and investment changes that should be effected to optimize synergies between health, environment and other relevant sectors.

“The signing of this landmark declaration," said Dr Luis G. Sambo, Regional Director of WHO Africa Regional Office,"is the first step towards saving the lives of millions of people from the harmful effects of changes in the environment. We will work together to promote strategic alliances between health and environment. I am delighted that we have managed to secure political commitment to catalyze institutional changes needed to improve the health and well being of communities in the region.”

After deliberations on a range of issues, delegates were convinced that the root causes of global environmental degradation are embedded in social and economic problems such as pervasive poverty, unsustainable production and consumption patterns, inequity of distribution of wealth and the debt burden. These result in malaria, tuberculosis, cholera, typhoid, dracunculiasis, helminthiasis, schizosomiasis, asthma, bronchitis and heart diseases that are taking their toll on millions of people living in the region.

"The Libreville declaration is a milestone for Africa. Nowhere is the human health impact of environmental threats more urgent" said Dr Maria Neira, WHO's Director for Department of Public Health and Environment. “The challenge now is to ensure Africa moves onto the global environmental health agenda."

Delegates highlighted the need to address health, environment and economic development issues in an interrelated manner to generate new synergies in poverty reduction and social equity. Ministers expressed their willingness to actively seek partnerships with civil society, including the private sector, and to seek their expertise in effecting change to improve environmental conditions in Africa.

Mme Angélique Ngoma, Minister of Health and Public Hygiene of Gabon, said "This conference will go down in the annals of Africa as the first to generate a synergy of political action and complementarity between health and environment for sustainable development."

The Declaration urges Member States among other things to:

1.Update their national sub-regional and regional frameworks in order to address more effectively the interlinkages between health and environment though integration of these links in policies, strategies and national development plans;

2.Ensure integration of the agreed objectives in the areas of health and environment in national poverty reduction strategies;

3.Implement priority intersectoral programmes at all levels in health and environment, aimed at accelerating the achievement of the Millennium Development Goals;

4.Build national and regional capacities to address the linkages between environment and health through the establishment and strengthening of health and environment institutions.

Expressing his appreciation at the outcomes of this landmark Inter-Ministerial Conference, UNEP's Regional Director for Africa , Mounkaila Goumandakoye said: “For too long both health and environment have sought to cope with the downstream consequences of policies regarding environment, health and economic development that have been designed in parallel, not in concert. In valuing the inextricable links between human health and the sustainability of ecosystems along with the goods and services they provide, this historic conference in Africa reasserts that the work of the environment sector is an issue of human well being and that together health and environment in acting proactively are critical development partners in the achievement of global and national development objectives.”

The four-day event held in Libreville, Gabon, was attended by hundreds of delegates, including Health Ministers, Ministers of Environment, high-level experts, academics, policy makers, bilateral & multilateral institutions and NGOs.

Note to Editors:

The full text of the Libreville Declaration and further information about the conference is available on the WHO AFRO, website can be accessed on the conference website http://www.unep.org or on the WHO AFRO website: http://www.afro.who.int

All WHO media information, press releases, fact sheets and statements can be found at: www.who.int.

WHO 25 08 2008

INEQUITIES ARE KILLING PEOPLE ON A "GRAND SCALE"

REPORTS WHO'S COMMISSION

LAUNCH of the WHO Report on the Social Determinants of Health

What: WHO's Commission on Social Determinants of Health (CSDH) will hand over its report to the World Health Organization (WHO) on the 28th August 2008 at 10h00 CET. Journalists are invited to attend the news conference.

Many of the differences in health between - and within - countries result from the social environment where people are born, live, grow, work and age. These "social determinants of health" have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state and former ministers of health. Together, they comprise the World Health Organization's Commission on the Social Determinants of Health. On the 28th August, the Commission will present its findings to the WHO Director-General Dr Margaret Chan. The Commission on Social Determinants of Health was established in 2005 by the late WHO Director-General, Dr LEE Jong-wook, to marshal evidence and make recommendations on reducing health inequities.

The Report in English and the Executive Summary in six UN languages and supporting media materials including a press release, backgrounders, country examples, figures, tables and graphs, B-Roll material including visuals, and a podcast including voices of the Commissioners, can be accessed at the following password protected website:

Felicity Porritt, Head of Communications, WHO Commission on the Social Determinants of Health, University College of London Secretariat, London. Mob: + 44.77.39.41.9219, Email: felicity.porritt@mac.com

All WHO media information, press releases, fact sheets and statements can be found at: www.who.int

WHO 19 08 2008

FLOODS IN WEST AFRICA RAISE MAJOR HEALTH RISKS

19 August 2008 | GENEVA -- Rising flood waters across West Africa are intensifying health risks for millions of people, and adding to the impact of the food price crisis. International aid is needed as heavy rains forecast to last until September could exacerbate health threats for conditions including malaria, diarrhea and other potentially fatal communicable diseases.

"West Africa's annual floods bring with them not only the threat of vector-borne and communicable diseases, but it further endangers the lives of people already malnourished by the food price crisis," said Dr Eric Laroche, Assistant Director-General of the World Health Organization's Health Action in Crises Cluster.

WHO is responding by providing essential medicines, assessing the health status of the vulnerable populations - particularly children, women and the elderly - and helping raise badly needed humanitarian funding. Some US$ 418 million was requested for West Africa in 2008's revised Consolidated Appeal for the region, of which US$ 76 million was needed for emergency health care. To date, only 22% of the health funding needs have been met.

Endemic and epidemic communicable diseases are common in West Africa, with malaria being the main cause of illness and death in the region. Meningitis, cholera and yellow fever also claim scores of lives annually and cause great human suffering, which is only expected to be intensified due to the extra strains placed by the floods on the health sector. An estimated 5 million people also live with HIV/AIDS in the region, whose health care is further compromised by the flooding.

The destruction of agriculture lands and loss of crops aggravates the food security crisis in the region. Several West African countries are among the 21 worldwide identified by WHO as being most at risk from the food crisis. Niger, Mali and Burkina Faso are above the global emergency threshold for malnutrition, with over 10% of children aged under five suffering from acute malnutrition and over 40% with chronic malnutrition. Acute malnutrition develops quickly in vulnerable populations and involves a rapid loss of weight and the greater potential for death, compared with chronic malnutrition (stunting), which develops over a longer time and affects the height and learning abilities of suffere

In Benin, 2008 flooding has displaced at least 150 000 people and raising fears of malaria, diarrhoeal diseases and respiratory infections, especially among children. WHO is helping supply clean water and provide appropriate sanitation, distribute bed nets and essential drugs, and undertake measles vaccinations for children. In Niger, 24 000 people have been displaced, while 12 000 have been displaced in Togo.

All WHO information, fact sheet and news releases are available at www.who.int.

WHO 05 08 2008

WHO AND WORLD BANK JOIN FORCES FOR BETTER RESULTS FROM GLOBAL HEALTH INVESTMENTS

Mexico City -- 5 August 2008 – As delegates gather at the International AIDS Conference (3-8 August), the World Health Organization (WHO) and the World Bank today address the pressing global debate around health systems and initiatives in specific aspects of health, nutrition and population. Critics claim that disease-specific initiatives are eroding already weak health systems, while others assert that weak health systems are holding back progress in disease-specific initiatives. In an effort to gather evidence and provide technical guidance in this area, WHO and the World Bank have agreed to join forces in collaboration with a wide range of interested stakeholders including country officials, academic and research institutions, Global Health Initiatives and civil society organizations.

During the past decade, global health initiatives have become a prominent part of the international aid architecture, bringing new resources, partners, technical capacity and political commitment. Examples include The Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, and the US President’s Emergency Plan for AIDS Relief, known as PEPFAR. Now numbering more than 80, these initiatives have contributed to a dramatic increase in the level of resources for health in low- and middle-income countries.

Notwithstanding the gains that have been made in funding and access to health services, critics allege that Global Health Initiatives have also exposed weaknesses in health systems. These weaknesses in overstressed health systems in many low- and middle- income countries are thought to be limiting the effectiveness of Global Health Initiatives and may be undermining investments that are now being made. The new effort will examine the issues in the debate, separate reality from rhetoric, and provide governments with sound technical guidance to enhance health systems without diminishing the benefits of disease specific initiatives.

“It is not about choosing between health systems strengthening on the one hand and disease-specific programmes on the other,” said Dr Carissa Etienne, WHO Assistant Director-General, Health Systems and Services, at a press conference during the XVIIth International Conference on AIDS in Mexico City. "It is about working together to generate added value. The time has come to move from observing the intentional and unintentional impacts of health investments, to actively managing better outcomes that can be sustained.”

The WHO-World Bank collaboration will examine and combine the strengths of different approaches around the world in order to get better results from investments and improve health outcomes for all.

“This collaboration will be useful at the country and global levels. We will generate new knowledge, work with countries to improve their approaches and share lessons at the regional and global levels,” says Julian Schweitzer, Director of Health, Nutrition and Population at the World Bank.

Note to editors:

The term “Global Health Initiative” refers to entities that mount a selective response to specific aspects of the global public health agenda. Some focus on developing, or increasing access to, specific health products such as drugs or vaccines (for example, the Global Alliance for Vaccines and Immunization or the African Programme for Onchocerciasis Control). Others attract, manage and allocate funding for a global response to specific diseases or health interventions (for example the Global Fund to Fight AIDS, Tuberculosis and Malaria or the Roll Back Malaria Global Partnership).

All WHO information, fact sheet and news releases are available at www.who.int.

WHO 05 08 2008

WHO LAUNCHES NEW HIV/AIDS GUIDE TO HELP COUNTRIES REACH UNIVERSAL ACCESS TO HIV AIDS PREVENTION

5 August 2008, MEXICO CITY, Mexico—Today, at the XVII International AIDS Conference in Mexico City, the World Health Organization (WHO) launched a package of priority interventions designed to help low- and middle-income countries move towards universal access to HIV/AIDS prevention, treatment, care and support.

Priority Interventions: HIV/AIDS prevention, treatment and care in the health sector is a compilation of WHO-recommended priority HIV/AIDS health-sector interventions. It includes everything from how to expand condom programming to the latest in treatment recommendations, guidelines and standards. The publication is designed to be a 'living' web-based document that will be periodically updated with new recommendations based on the rapidly evolving experience of the health-sector response.

"This document responds to a long standing country need," says WHO HIV/AIDS Department Director, Dr Kevin M. De Cock. " In one place it captures WHO's best guidance on what the global HIV/AIDS health-sector response needs to deliver".

To that end, WHO has developed this package to promote the more efficient use of existing recommendations specifically aimed at resource-limited settings. This, its authors state, will help enable countries to meet their commitment made two years ago at the United Nations General Assembly High-Level Meeting on AIDS to provide universal access to HIV prevention, treatment, care and support by 2010.

guide the selection and prioritization of interventions for HIV prevention, treatment and care; and

direct readers to key WHO resources and references containing the best available information on the health-sector response to HIV/AIDS.

The scale-up of HIV treatment in the world's poorest countries is greatly strengthening the health sector in many ways such as the establishment and expansion of infrastructure, including labs and clinics, a stronger health workforce, more efficient procurement and supply management systems and sustained financing.

WHO is initially launching the document on a CD-Rom but will make it available in several formats, including in hard copy and on the web. The intent is to share information and allow partners to learn from, and contribute their expertise to, the health-sector response to HIV/AIDS.

All WHO information, fact sheet and news releases are available at www.who.int.

WHO 04 08 2008

TARGETED ACTION ON HIV AND TUBERCULOSIS NEEDED TO REACH DRUG USERS

4 August 2008 -- Mexico City -- Health and criminal justice authorities need to provide targeted services to drug users, especially those who inject drugs, to prevent and treat tuberculosis (TB) and HIV. TB is a major cause of death for people living with HIV, but drug users who are HIV positive face stigma, discrimination and barriers to accessing life-saving treatments.

New guidelines issued today aim to reduce these preventable deaths by, for example, improving access to antiretroviral drugs and to isoniazid for drug users living with HIV. Isoniazid preventive therapy (IPT) significantly reduces the risk of TB disease in people living with HIV, but is not widely used.

These are the first recommendations to actively include TB and HIV care within the context of support to drug users. They form part of the Evidence for Action series and build on policy guidance on both TB/HIV and injecting drug use.

Even where IPT is available, health care and outreach workers face major challenges in delivering full care to drug users who are often marginalised by homelessness, poverty, imprisonment, and by public and political hostility. These factors contribute to the transmission of both HIV and TB, and at the same time are barriers to TB, HIV and drug dependence treatment.

To ensure all drug users, including those in prison, can benefit from TB and HIV prevention, treatment support and care, WHO, UNAIDS and the UN Office on Drugs and Crime have developed Policy Guidelines for Collaborative TB and HIV services for Injecting and Other Drug Users - An Integrated Approach. The measures* aim to break down the barriers that stand in the way of better health, outline key interventions, and promote ways to improve coordination and planning across all those who interact with injecting and other drug users.

HIV weakens a person's immune system. Because of this, people living with HIV are up to 50 times more likely to develop TB in their lifetimes than people who are HIV negative. Without proper treatment, the majority of people living with HIV die within two to three months of becoming sick with TB. In 2006, 231,000 people died with HIV and TB. Many of these deaths were preventable.

Unsafe injecting drug use is now a major route of transmission for HIV. Excluding Africa, nearly one in three of all new HIV infections are attributable to unsafe injecting drug use. In areas of eastern Europe and central Asia, that figure rises to two out three new infections. In some areas of eastern Europe a significant association between HIV and multidrug-resistant TB has been observed by researchers.

Addressing TB/HIV is a key theme of the 2008 International AIDS Society conference and comes two months after world leaders issued a call to drastically cut the number of TB/HIV deaths by 2015 at the landmark Global Leaders' Forum on the co-epidemic, held at the UN headquarters in New York.

*Summary of the 13 recommendations in the Policy Guidelines for Collaborative TB and HIV services for Injecting and Other Drug Users:

Joint Planning:

1.Multisectoral coordination on TB and HIV activities for drug users

2.National plans with roles and responsibilities of service providers

3.Staff training to build effective teams

4.Operational research on TB/HIV services for drug users

Key Interventions:

5. TB infection control in congregate settings including prisons

6. Case-finding protocol for TB and HIV for services dealing with drug users

7. Access to appropriate treatments for drug users

8. Isoniazid preventive therapy for drug users living with HIV

9. Health workers to assess and provide HIV prevention methods

Overcoming Barriers:

10. Universal access to TB and HIV prevention, treatment and care as well as drug treatment services to drug users

UNITAID, UNICEF AND WHO ANNOUNCE MASSIVE SCALE-UP IN FIGHT AGAINST HIV IN MOTHERS AND CHILDREN

GENEVA/MEXICO CITY/NEW YORK, 31 July 2008— As the world's leaders and AIDS community gather in Mexico for the biennial global conference on HIV and AIDS, UNITAID, UNICEF and the World Health Organization (WHO) today announced an infusion of $50 million aimed at halting mother-to-child transmission of HIV.

Over the next two years, UNITAID funding will be used to test some 10 million pregnant women for HIV and treat 285 000 mothers and children in nine target countries: Central African Republic, China, Haiti, Lesotho, Myanmar, Nigeria, Swaziland, Uganda, and Zimbabwe. These countries represent approximately 25% of the world's HIV-infected pregnant women giving birth annually.

"This effort aims to go beyond mere prevention by promoting ongoing treatment for mothers and their babies," said Dr Philippe Douste-Blazy, Chair of UNITAID's Executive Board. "Our aim is to fund the most effective and appropriate medicines and diagnostics on the market for both women and children."

A novel element of the project is that it will allow UNICEF to negotiate reduced drug prices, allowing for a greater scale-up of more effective treatment for HIV-infected women as well as aim to prevent infection in their children. This ramping up means the WHO-recommended treatment protocol – introduced in 2006 and a far superior solution to the single therapy Nevirapine – can be implemented much more quickly and intensively.

Funding will also provide a one-year course of antiretroviral treatment to HIV positive pregnant women in need, in the nine countries.

“Testing pregnant women for HIV gives mothers a better chance to survive this disease,” said Ann M. Veneman, UNICEF Executive Director. ”Women, their children and their entire communities benefit when life-saving treatment is provided to HIV positive mothers as quickly as possible.”

WHO will ensure that expansion of programmes, use of antiretroviral medicines and procurement of commodities are done according to published guidelines and recommendations through close collaboration with Ministries of Health. WHO will also provide support in monitoring and evaluating prevention-of-mother-to-child transmission programmes to meet national targets.

"Women are one of the main target groups for WHO action," said Dr Margaret Chan, WHO Director-General. "Women play an important role in the functioning of communities, in caring for and educating children and make invaluable contributions to societies' development."

The three agencies are already funding and providing commodities to prevent mother to child HIV transmission in eight African countries, representing approximately 342 000 women.

About UNITAID

UNITAID is an international financing facility committed to the scale-up of treatment and care for HIV/AIDS, malaria and tuberculosis. It was founded in 2006 by Brazil, Chile, France, Norway and the United Kingdom. Currently, UNITAID is supported by 27 countries - 19 of which are developing or transition countries - and the Gates Foundation. In less than two years of operation, UNITAID has disbursed US$ 280 million and committed US$ 200 more for the purchase of health commodities for the poorest countries.

About UNICEF

UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from

violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

About WHO

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

­­­­All WHO information, fact sheet and news releases are available at www.who.int.

WHO 11 07 2008

HEALTH CRISES HEIGHTEN HUMINATARIAN DESPAIR IN ETHIOPIA

11 JULY 2008 / GENEVA/ADDIS ABABA -- Worsening malnutrition and the threat of disease outbreaks are compounding Ethiopia's humanitarian crisis. The World Health Organization is working with the Government of Ethiopia and health partners to support the 4.6 million people needing urgent emergency food relief nationwide.

The number of people needing food assistance is increasing markedly in Ethiopia, and health risks are being compounded by the global food security crisis, the impact of drought on agricultural production and the country's weak health system. During the coming months, annual rains are expected to again cause large-scale flooding, increasing loss of crops and risk of disease.

"In humanitarian terms, the situation is unacceptable," said Dr Eric Laroche, Assistant Director-General for WHO's Health Action in Crises Cluster. "The health of millions of Ethiopians is worsening by the day, and the international community must act to support the country's government to ease this terrible suffering."

In three regions alone (Somali, SNNP and Eastern Oromiya), the number of government-run feeding centres has risen from 200 three months ago to 605 today. Some 75 000 children aged under 5 need therapeutic and supplementary nutrition support. WHO, UNICEF and nongovernmental organization partners are supporting these centres.

Additional major gaps affecting people’s health and livelihoods are lack of access to safe drinking water, shortages of drugs and medical supplies and insufficient human resources. The areas affected by shortages are also at significant risk of disease outbreaks: diarrhoeal diseases, measles and meningitis. Cases of acute watery diarrhoeal have been reported in 16 districts, and outbreaks of cerebrospinal meningitis in 37 districts. More than 7000 cases of measles have been registered in 38 districts.

WHO works with Federal and regional government partners, UN agencies and nongovernmental organizations to provide better health and nutrition services throughout Ethiopia using emergency mobile teams; deploy drugs, medical and nutrition supplies and staff for emergency action in affected areas; plan the rolling out outpatient therapeutic programmes in the health extension programme which promotes the primary health care approach in Ethiopia; and strengthen disease and nutritional surveillance systems to enable rapid response.

IAEA Member States and International Organizations Conclude Testing of

Emergency Plans

Geneva, 11 July 2008 –The World Health Organization (WHO) completed a two-day emergency radiation exercise today. This test involved a simulated accident at the Laguna Verde nuclear power plant in Mexico. It was coordinated by the International Atomic Energy Agency (IAEA), together with 74 of its Member States and 9 international organizations.

The test utilized all WHO systems including Headquarters in Geneva, Regional Headquarters in Washington, and the Country Office in Mexico. Permanent coordination was established with the Emergency Unit and National Focal Point for IHR (2005) of the Ministry of Health of Mexico.

Results of the exercise are currently being evaluated.

This exercise is a crucial part of the international efforts to be fully prepared to respond to any radiological or nuclear incident or emergency worldwide. Under the International Health Regulations (2005), and as the lead health agency within the United Nations, WHO has a mandate to coordinate any international public health response to all types of public health risks and emergencies, including radio-nuclear events.

The IAEA’s Incident and Emergency Centre (IEC) and emergency operations centres of Member States and international organizations were fully activated as part of the exercise. The IEC received notification of the simulated accident from Mexico and informed participating Member States and international organizations about the test emergency. The Centre also coordinated the response to requests for assistance to the affected Member States

The exercise was prepared by the Working Group on Coordinated International Exercises as part of the Inter-Agency Committee for Response to Nuclear Accidents (IACRNA). For this exercise the group comprised the IAEA, the Food and Agricultural Organization of the United Nations (FAO), the Nuclear Energy Agency of the Organization for Economic Co-operation and Development (OECD/NEA), the World Health Organization (WHO), the World Meteorological Organization (WMO), Mexico and the Mexican neighbouring countries.

INTERNATIONAL ORGANIZATIONS AND IAEA MEMBER STATES TO TEST EMERGENCY PLANS

Geneva, 8 July 2008 – In an effort to strengthen public health emergency response, the World Health Organization (WHO) will take part in a test of radiation emergency plans through a simulated accident at the Laguna Verde Nuclear power plant, Mexico, 9-10 July 2008. This exercise is coordinated by the International Atomic Energy Agency (IAEA). It is being carried out in co-operation with 74 IAEA Member States and nine international organizations in order to test national and international preparedness to respond to a nuclear or radiological emergency.

In this exercise WHO will be testing in particular its Strategic Health Operations Centre and the Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) as key tools of WHO's activities for public health risk detection, assessment and response under the umbrellas of the two Emergency Conventions and the International Health Regulations (IHR-2005). In particular, the WHO Regional Office for Americas (AMRO/PAHO) and the WHO Country Office in Mexico are expected to interact with the National IHR Focal Point of Mexico to test communication channels under the IHR.

Exercises of the international plan, called the “Joint Radiation Emergency Management Plan”, are conducted every few years so that the IAEA, its Member States and international organizations can test preparedness for working cooperatively to respond effectively to an actual nuclear or radiological emergency or incident.

This exercise is focused primarily on testing communication networks and international assistance mechanisms.This exercise will provide an opportunity for WHO, its participating collaborating centres and WHO Regional Office in the America's to test critical elements of public health emergency response, including communications, coordination of activities within WHO, with IAEA as well as with other international agencies.

The exercise is only a simulation and there are no actual risks or hazards to the general public.

The exercise preparation is being coordinated by the Working Group on Coordinated International Exercises as part of the Inter-Agency Committee for Response to Nuclear Accidents (IACRNA). For this exercise the group comprises of the IAEA, the Food and Agricultural Organization of the United Nations (FAO), the Nuclear Energy Agency of the Organization for Economic Co-operation and Development (OECD/NEA), the World Health Organization (WHO), the World Meteorological Organization (WMO), Mexico and its neighboring countries.

WHO 08 07 2008

WHO WELCOMES G8 AGREEMENT TO ANNUAL REVIEWS OF COMMITMENTS TO PROGRESS IN GLOBAL HEALTH

GENEVA - The World Health Organization (WHO) welcomes the agreement announced today in Japan by G8 leaders and their commitment to full, annual measurements of progress in meeting their pledges to improve global health.

"Many noble commitments have been made over the last decade to support health," said WHO Director-General Margaret Chan. "And now G8 nations are saying they will ensure an accounting of those promises every year. This is commendable. WHO and its partners will do everything possible to support their efforts."

The G8 also agreed that the Millennium Development Goals (MDGs), adopted by the UN in 2000, should be supported in a comprehensive manner. In particular, G8 noted the need:

to greatly increase progress on maternal, newborn and child health;

to reaffirm, sustain and extend previous commitments on HIV, tuberculosis and malaria, as well as on polio and neglected tropical diseases; and

to strengthen health systems, including social health protection and building an adequate health workforce with a voluntary code of practice regarding ethical recruitment of health workers.

"The G8 has taken an important step to relieve suffering and improve the health of the world's most vulnerable people," said Dr Chan. "I applaud the strong commitment of all G8 leaders. I would also like to thank the Government of Japan for its leadership of this meeting."

RAPID TESTS FOR DRUG RESISTANT TB TO BE AVAILABLE IN DEVELOPING COUNTRIES

Geneva -- People in low-resource countries who are ill with multidrug-resistant TB (MDR-TB) will get a faster diagnosis -- in two days, not the standard two to three months -- and appropriate treatment thanks to two new initiatives unveiled today by the World Health Organization (WHO), the Stop TB Partnership, UNITAID and the Foundation for Innovative New Diagnostics (FIND).

MDR-TB is a form of TB that responds poorly to standard treatment because of resistance to the first-line drugs isoniazid and rifampicin. At present it is estimated that only 2% of MDR-TB cases worldwide are being diagnosed and treated appropriately, mainly because of inadequate laboratory services. The initiatives announced today should increase that proportion at least seven-fold over the next four years, to 15% or more.

"I am delighted that this initiative will improve both the technology needed to diagnose TB quickly, and increase the availability of drugs to treat highly resistant TB," said British Prime Minister Gordon Brown, who helped launch the Stop TB Partnership's Global Plan to Stop TB in 2006 and whose government is a founding member of UNITAID. "The UK is committed to stopping TB around the world, from our funding of TB prevention programmes in poor countries, to our support of cutting edge research to develop new drugs."

In developing countries most TB patients are tested for MDR-TB only after they fail to respond to a standard treatments. Even then, it takes two months or more to confirm the diagnosis. Patients have to wait for the test results before they can receive life-saving second-line drugs. During this period, they can spread the multidrug-resistant disease to others. Often the patients die before results are known, especially if they are HIV-infected in addition to having MDR-TB.

The initiative comes just one week after WHO recommended "line probe assays" for rapid MDR-TB diagnosis worldwide. This policy change was driven by data from recent studies, including a large field trial--conducted by FIND together with South Africa's Medical Research Council and National Health Laboratory Services--which produced evidence for the reliability and feasibility of using line probe assays under routine conditions.

"Five months ago, WHO renewed its call to make MDR-TB an urgent public health priority," said WHO Director-General Dr Margaret Chan, "and today we have evidence to guide our response. Based on that evidence, we are launching these promising initiatives."

The new initiative consists of two projects. The first, made possible through $26.1 million in funding from UNITAID*, will introduce a molecular method to diagnose MDR-TB that until now was used exclusively in research settings. These rapid, new molecular tests, known as line probe assays, produce an answer in less than two days.

Over the next four years -- as lab staff are trained, lab facilities enhanced and new equipment delivered -- 16 countries** will begin using rapid methods to diagnose MDR-TB, including the molecular tests. The countries will receive the tests through the Stop TB Partnership's Global Drug Facility, which provides countries with both drugs and diagnostic supplies.

As part of the project, WHO's Global Laboratory Initiative and FIND will help countries prepare for installation and use of the new rapid diagnostic tests, ensuring necessary technical standards for biosafety and the capacity to accurately perform DNA-based tests. One country, Lesotho, is already equipped to start using these tests; Ethiopia is expected to be ready by the end of 2008. The tests will be phased in from 2009-2011 in the remaining 14 countries.

Under a second, complementary agreement with UNITAID for US$ 33.7 million, the Global Drug Facility will boost the supply of drugs needed to treat MDR-TB in 54 countries, including those receiving the new diagnostic tests. This project is also expected to achieve price reductions of up to 20% for second-line anti-TB drugs by 2010. All the countries receiving this assistance have met WHO's technical standards for managing MDR-TB and already have treatment programmes in place. Some will use grants from the Global Fund against AIDS, Tuberculosis and Malaria to purchase the drugs.

"Through the US$ 60 million support provided by UNITAID, these projects are expected to produce significant results in diagnosing and treating patients as well as reducing drug prices and the costs of diagnosis. These efforts illustrate the way in which innovative financing can be deployed for health and development," said Philippe Douste-Blazy, Chairman of UNITAID's Executive Board.

*UNITAID is an international drug purchase facility, established to provide long-term, sustainable and predictable funding to increase access and reduce prices of quality drugs and diagnostics for the treatment of HIV/AIDS, malaria and tuberculosis in developing countries.

** Negotiations are being carried out with the following countries for MDR-TB diagnostics:

25 JUNE 2008 | GENEVA / WASHINGTON DC -- With major surgery now occurring at a rate of 234 million procedures per year - one for every 25 people - and studies indicating that a significant percentage result in preventable complications and deaths, the World Health Organization (WHO) launched a new safety checklist for surgical teams to use in operating theatres, as part of a major drive to make surgery safer around the world

"Preventable surgical injuries and deaths are now a growing concern," said Dr Margaret Chan, Director-General of WHO. "Using the Checklist is the best way to reduce surgical errors and improve patient safety."

Several studies have shown that in industrial countries major complications are reported to occur in 3-16% of inpatient surgical procedures, with permanent disability or death rates of approximately 0.4-0.8%. In developing countries studies suggest a death rates of 5-10 % during major surgery. Mortality from general anaesthesia alone is reported to be as high as one in 150 in parts of sub-Saharan Africa. Infections and other postoperative complications are also a serious concern around the world. These studies suggest that approximately half of these complications may be preventable.

"Surgical care has been an essential component of health systems worldwide for more than a century.' said Dr Atul Gawande, a surgeon and professor at Harvard. "Although there have been major improvements over the last few decades, the quality and safety of surgical care has been dismayingly variable in every part of the world. The Safe Surgery Saves Lives initiative aims to change this by raising the standards that patients anywhere can expect."

The Safe Surgery Saves Lives initiative is a collaborative effort lead by the Harvard School of Public Health today and involving more than 200 national and international medical societies and ministries of health in a effort to meet the goal of reducing avoidable deaths and complications in surgical care. Now, the WHO Surgical Safety Checklist, developed under the leadership of, Dr Gawande identifies a set of surgical safety standards that can be applied in all countries and health settings.

Preliminary results from a thousand patients in eight pilot sites worldwide indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care. Use of the checklist in pilot sites has increased adherence to these standards of care from 36% to 68% and in some hospitals to levels approaching 100%. This has thus far resulted in substantial reductions in complications and deaths in this group. Final results on the checklist effect are anticipated within the next few months.

The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: before induction of anaesthesia (‘Sign In’), before skin incision (‘Time Out’) and before the patient leaves the operating room (‘Sign Out’). In each phase a checklist coordinator must be permitted to confirm that the team has completed its tasks before it proceeds with the operation. For example, during the "Sign in " phase was the surgical site marked and the patient's know allergies checked , or during the "Sign out" phase where instruments, sponges and needles counted.

The WHO Guidelines and Checklist released today are the first edition. They will be finalized for dissemination by the end of 2008, after completion of evaluation in 8 pilot sites globally.

* The World Alliance for Patient Safety is a World Health Organization programme launched in 2004. The Alliance is chaired by Sir Liam Donaldson, Chief Medical Officer of the United Kingdom. Further information on the work of the Alliance is available at www.who.int/patientsafety/en/

* The World Alliance for Patient Safety issues its 2006-2007 Progress Report and 2008-2009 Forward Programme on the 25 June 2008. Further information on the Alliance reports is available at www.who.int/patientsafety/en/

GENEVA -- Safer Water for Better Health is the first-ever report providing country-by-country estimates of the burden of disease due to poorwater, sanitation and hygiene. The report highlights how much disease could be prevented through increased access to safe water and better hygiene.

This comprehensive overview demonstrates the financial returns on investments in fully integrating water, sanitation and hygiene as part of countries' disease reduction strategies -- a pre-requisite to achieving the Millennium Development Goals. The report also provides basis for consideration in the decision making process by the health sector and those sectors managing critical water resources and services.

Lack of safe water, sanitation and hygiene remains some of the world’s most urgent health issues.

China and the United Arab Emirates (UAE) have made impressive strides in tackling the risk of contamination from unsafe blood by reaching close to 100% voluntary blood donation , said the World Health Organization today . Their efforts to increase their safe blood base will be promoted as models for other countries to follow on the occasion of World Blood Donor Day, on 14 June.

Compared to 1998, when systems of paid donations or donations from family members made up 80% of its blood supplies, China has achieved 98.5% voluntary donations in just 10 years. The UAE went from 0% of voluntary donations in 1990 to 80% in 2004 and 97.6% in 2006.

“Access to safe blood is a key component of effective health care and voluntary donors are the cornerstone of a safe blood supply,” said Carissa Etienne, Assistant Director-General for Health Systems at the World Health Organization (WHO). “Available, safe blood is particularly crucial to the health of women and children.”

WHO’s most recent figures on blood donation show that only 54 countries globally have achieved 100% voluntary donation, including, most recently, Thailand, Turkey and Uganda.

Studies reveal that some governments perceive the task of mobilizing the population to donate blood without payment or family interest as insurmountable. But China and the UAE have shown that it is possible to change donor behaviour in a very short time.

"Thanks to the strong commitment of the Government and extensive national and local campaigns, a huge shift occurred in the way Chinese people think about blood donation," said Peter Carolan, Senior Officer at the International Federation of Red Cross and Red Crescent Societies. "That shift became even more apparent last month, when thousands of people queued up all over the country to give blood to help the Sichuan earthquake victims."

To thank regular voluntary donors, China will award the very first gold medals - called 'medals for life' - this year to donors who have reached the 20 voluntary blood donations mark. Replicas of the medals in the form of lapel pins will be given to voluntary donors who give blood from World Blood Donor Day, on 14 June, to the beginning of the Olympic Games.

The UAE was the first country in the region to stop importing blood in 1984, after the discovery of HIV/AIDS. In 1990, the Government established a national blood transfusion programme and took legislative and policy measures to move to a system of 100% voluntary unpaid blood donation.

These rapid strides were made possible by creating an enabling political environment, fostering a culture of voluntary blood donation, using media and other channels to raise awareness, building a stable blood donor pool and providing quality care for donor health and safety.

"The UAE has clearly demonstrated the power of political commitment and community involvement and sets an example we hope other countries will follow," said Neelam Dhingra, Coordinator of Blood Transfusion Safety at WHO.

Less than 45% of the global blood supply is collected in developing and transitional countries which are home to about 80% of the world's population. These countries bear the world's heaviest burden of disease and therefore need an adequate and safe supply of blood and blood products, particularly for life-threatening conditions such as severe anaemia in children due to malaria and poor nutrition, and haemorrhage and other pregnancy-related complications in women.

Voluntary blood donors are the safest source of blood. They donate of their own free will, without pressure, coercion or payment, and are therefore less likely to hide information about their health status and behaviour that may make them ineligible to donate blood. Regular voluntary donation guarantees a sufficient and sustainable blood supply. Progress to 100% voluntary blood donation shifts the burden of arranging blood for transfusion by a patient or family to the health care system.

Note for editors/reporters

This year's World Blood Donor Day theme is “Giving Blood Regularly”- an effort to commit volunteer blood donors to donate regularly and over the long-term. Slogans such as “Many Happy Returns” and “Once Is Not Enough” will echo across the world to emphasize the importance of regular donation by eligible donors to a safe and sustainable national blood supply.

On 14 June, most countries will celebrate the day with local events and activities. This year's main event is hosted by the Government of UAE under the direct patronage of President Sheikh Khalifa bin Zayed Al Nahyan.

WHO works with partners internationally and in countries to promote better blood collection practices, 100% voluntary, unpaid blood donation policies, quality assured blood testing and rational use of blood.

WHO, the International Federation of the Red Cross and Red Crescent Societies, the International Society of Blood Transfusion and the International Federation of Blood Donor Organizations joined forces in 2004 to celebrate for the first time World Blood Donor Day — a tribute to voluntary, unpaid blood donors who altruistically give of themselves to improve and save lives. In 2005 the World Health Assembly voted a resolution to make World Blood Donor Day an annual event. Since then, the Day has become a vehicle to launch national and regional awareness and advocacy campaigns to encourage blood donation and safer practices in blood transfusion.

We wish to clarify misinterpretations concerning WHO and UNAIDS positions on the status of the AIDS epidemic in recent media articles. The story in the Independent on Sunday titled:“Threat of world AIDS pandemic among heterosexuals is over, report admits” contained a few seriously misleading statements that have led to inferences and conclusions that bear no relation to the highly complex realities of the HIV epidemic.

First and foremost, the global HIV epidemic is by no means over. At the end of 2007, an estimated 33.2 million people were living with HIV. Some 2.5 million people became newly infected that year, and 2.1 million died of AIDS. AIDS remains the leading cause of death in Africa.

Worldwide, HIV is still largely driven by heterosexual transmission. The majority of new infections in Sub-Saharan Africa occur through heterosexual transmission. We have also seen a number of generalized epidemics outside of Africa, such as in Haiti and Papua New Guinea.

Heterosexual transmission continues to drive the epidemic among sex workers, their clients, and their clients' partners. In addition, prisoners, injecting drug users, as well as men who have sex with men, may also engage in heterosexual relationships. In sub-Saharan Africa almost 60% of adults living with HIV were women: 48% in the Caribbean.

HIV prevention and treatment efforts are showing results. Building on these successes will require improved outreach to populations most at risk with evidence-informed approaches based on local HIV epidemiology — an approach we call “knowing your epidemic.” In all settings, a supportive environment is required, free from stigma and discrimination, legal barriers or other obstacles that prevent access to services. AIDS awareness campaigns and school-based efforts are essential to promote sexual and reproductive health, ensuring young people have the knowledge and ability to protect themselves against sexually transmitted diseases, and teenage pregnancy.

UNAIDS and WHO remain focused on strengthening monitoring of the epidemic to refine responses further and to recognize changes in transmission patterns should they occur.

To recap: AIDS remains the leading infectious disease challenge in global health. To suggest otherwise is irresponsible and misleading.

WORLD LEADERS AT UN MEETING CALL FOR JOINT ACTION TO REDUCE TUBERCULOSIS DEATHS AMONG PEOPLE LIVING WITH HIV

9 June 2008, New York City - For the first time ever, heads of government, public health and business leaders, heads of UN agencies and activists came together at UN Headquarters today to confront a threat to global health that could undermine investments in life-saving drug treatment for people living with HIV.

Tuberculosis (TB) is taking the lives of nearly a quarter of million people living with HIV each year. TB is the number one cause of death among people living with HIV in Africa. Worldwide it is a leading cause of death in this population.

The World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Children’s Fund (UNICEF) recently announced that some three million people are now receiving life-saving anti-retroviral treatment, but TB, especially drug-resistant forms of the disease, threatens to hinder this progress. Because HIV weakens the immune system people living with HIV are up to 50 times more likely to develop TB disease over their lifetimes than people who are HIV negative. Without proper treatment with anti-TB drugs, the majority of people living with HIV die within two to three months of becoming sick with TB.

The leaders spelt out specific measures, recommended by WHO*, needed to avert deaths from HIV/TB. People living with HIV must be screened regularly for TB. Those who are sick with TB need effective TB treatment, and those without TB disease should receive preventive therapy with the drug isoniazid. These treatments are not expensive. A six-month course of TB treatment costs US$ 20, and a course of preventive drug therapy costs US$ 2. Simple measures to prevent the spread of TB among HIV-infected people, especially in health care settings, also need to be put in place.

In 2006, WHO reported that only 1% of the total estimated number of people infected with HIV worldwide were screened for TB. But some countries are making gains on detecting HIV among TB patients and providing life-saving treatments for both diseases.

Kenya, Malawi and Rwanda, for example, more than doubled the proportion of TB patients tested for HIV infection and treated appropriately between 2004 and 2007, according to national government data. In Kenya, the percentage of TB patients tested for HIV rose from 19% to 70%, and in Malawi the increase was from 25% to 83%. In Rwanda, in 2004, TB services were not testing any patients for HIV; in 2007, they tested 89%.

Today's HIV/TB Global Leaders' Forum was convened by the UN Secretary-General's Special Envoy to Stop TB, Dr Jorge Sampaio, and endorsed by the UN Secretary-General Ban Ki-moon. The Forum was opened by the Secretary-General and Mr Srgjan Kerim, President of the UN General Assembly.

The leaders pointed to HIV/TB as a major constraint to economic development, since most TB deaths are among adults of working age. Because it most often strikes society's most disadvantaged people, they said, the dual epidemic is a barrier to social justice and human rights. They also warned that HIV/TB could evolve as a threat to global health security, particularly in the light of emergence of virtually untreatable TB strains.

Dr Sampaio will report on the outcome of the forum to the UN High-Level Meeting on AIDS, which begins tomorrow. Today's forum was supported by UNAIDS, the World Bank, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership.

NEARLY THREE MILLION HIV-POSITIVE PEOPLE NOW RECEIVING LIFE-SAVING DRUGS

But access to prevention and treatment still lacking for millions

Geneva, 2 June 2008 — The close of 2007 marks an important step in the history of the HIV/AIDS epidemic. Nearly 3 million people are now receiving antiretroviral therapy (ART) in low- and middle-income countries, according to a new World Health Organization (WHO), UNAIDS and UNICEF

report launched today.

Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector also points to other gains. These include improved access to interventions aimed at preventing mother-to-child transmission of HIV (PMTCT), expanded testing and counselling, and greater country commitment to male circumcision in heavily affected regions of sub-Saharan Africa.

“This represents a remarkable achievement for public health,” says WHO Director-General Margaret Chan. “This proves that, with commitment and determination, all obstacles can be overcome. People living in resource-constrained settings can indeed be brought back to economically and socially productive lives by these drugs.”

Millions now accessing treatment

According to report authors, the close of 2007 saw nearly one million more people (950 000) receiving antiretroviral therapy—bringing the total number of recipients to almost 3 million. The latter figure was the target of the „3 by 5‟ initiative that sought to have 3 million HIV-positive individuals living in low-and middle-income countries on treatment by 2005. Although that target was not achieved until two years later, it is widely credited with jump-starting the push towards ART scale-up.

According to the report, the rapid scale-up of ART can be attributed to a number of factors, including the:

o Increased availability of drugs, in large part because of price reductions;

o Improved ART delivery systems that are now better adapted to country contexts. The WHO public health approach to scale-up emphasizes simplified and standardized drug regimens, decentralized services and judicious use of personnel and laboratory infrastructure;

o Increased demand for ART as the number of people who are tested and diagnosed with HIV climbs.

Greater access: greater need

Report authors state that, overall, some 31% of the estimated 9.7 million people in need of ART received it by the end of 2007. That means that an estimated 6.7 million in need are still unable to access life-saving medicines.

“This report highlights what can be achieved despite the many constraints that countries face and is a real step forwards towards universal access to HIV prevention, treatment care and support,” says Dr Peter Piot, Executive Director of UNAIDS. “Building on this, countries and the international community must now also work together to strengthen both prevention and treatment efforts.”

WHO 30 05 2008

WHO WANTS A BAN ON ALL TOBACCO ADVERTISING TO PROTECT YOUTH

30 May, Geneva - The World Health Organization (WHO) today urged governments to protect the world’s 1.8 billion young people by imposing a ban on all tobacco advertising, promotion and sponsorship.

The WHO call to action comes in advance of World No Tobacco Day, 31 May. This year’s campaign focuses on the multi-billion dollar efforts of tobacco companies to attract young people to its addictive products through sophisticated marketing.

Recent studies prove that the more young people are exposed to tobacco advertising, the more likely they are to start smoking. Despite this, only 5% of the world’s population is covered by comprehensive bans on tobacco advertising, promotion and sponsorship. Tobacco companies, meanwhile, continue targeting young people by falsely associating use of tobacco products with qualities such as glamour, energy and sex appeal.

“In order to survive, the tobacco industry needs to replace those who quit or die with new young consumers,” said WHO Director-General, Margaret Chan. "It does this by creating a complex ‘tobacco marketing net’ that ensnares millions of young people worldwide, with potentially devastating health consequences."

“A ban on all tobacco advertising, promotion and sponsorship is a powerful tool we can use to protect the world’s youth,” the Director-General added.

Since most people start smoking before the age of 18, and almost a quarter of those before the age of 10, tobacco companies market their products wherever youth can be easily accessed – in the movies, on the Internet, in fashion magazines and at music and sports venues. In a WHO world wide school-based study of 13-15 year-olds, more than 55% of students reported seeing advertisements for cigarettes on billboards in the previous month, while 20% owned an item with a cigarette brand logo on it.

But it is the developing world, home to more than 80% of the world’s youth, which is most aggressively targeted by tobacco companies. Young women and girls are particularly at risk, with tobacco companies seeking to weaken cultural opposition to their products in countries where women have traditionally not used tobacco.

“The tobacco industry employs predatory marketing strategies to get young people hooked to their addictive drug,” said Dr Douglas Bettcher, Director of WHO’s Tobacco Free Initiative. "But comprehensive advertising bans do work, reducing tobacco consumption by up to 16% in countries that have already taken this legislative step."

"Half measures are not enough," added Dr Bettcher. "When one form of advertising is banned, the tobacco industry simply shifts its vast resources to another channel. We urge governments to impose a complete ban to break the tobacco marketing net," he said.

24 May 2008 | Geneva -- The 61st World Health Assembly, which comprised of a record 2704 participants from 190 nations, today set the World Health Organization on a course to tackle longstanding, new and looming threats to global public health. Among its achievements, the Health Assembly produced a public health breakthrough by providing a platform for removing barriers and using innovative methods to encourage research, development and access to medicines for the common diseases of the developing world.

"This is a major breakthrough for public health that will benefit many millions of people for many years to come," said WHO Director-General Margaret Chan. "This is a contribution to fairness in health and this is pro-active public health at its very best."

The "public health, innovation and intellectual property" strategy endorsed by the Health Assembly is designed to promote new approaches to pharmaceutical research and development (R&D), and to enhance access to medicines. It is also designed to provide a medium-term framework for enhancing and making sustainable essential R&D relevant to diseases impacting developing countries. The strategy proposes clear objectives and priorities, and estimates of funding needs in this area.

Delegates to the Health Assembly directly confronted major public health challenges which are now results of complex interactions of factors beyond health.

"At this World Health Assembly, we witnessed the interplay between the political, trade and health interests," said the President of the Health Assembly, Dr Leslie Ramsammy who is the Minister of Health of Guyana. "Child and maternal death, prevention and management of noncommunicable diseases rely on the supply chain and commodities. We are now much closer to having an increased flow of quality health commodities that will lead to better health."

The Health Assembly endorsed a six-year action plan to tackle what are now the leading threats to human health: noncommunicable diseases. These diseases - particularly cardiovascular diseases, diabetes, cancers and chronic respiratory diseases - caused 60% of all deaths globally in 2005 (estimated at 35 million deaths). Low- and middle-income countries are the worst affected by these diseases which are largely preventable by modifying four common risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.

Delegates also requested WHO - through a resolution - to intensify its work to curb harmful use of alcohol, which is the fifth leading risk factor for death and disability in the world. They called upon WHO to develop a global strategy for this purpose. The work on the strategy will start immediately and Member States will be consulted throughout the drafting process. The resolution also requests the Director- General to consult with intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways they could contribute to reducing harmful use of alcohol.

Delegates to the Health Assembly also requested WHO and committed their own Ministries of Health to take action to protect health from climate change. They adopted a resolution that urges Member States to take decisive action to address health impacts from climate change, warning of its potential risks on human health. The resolution calls on the health sector to scale up adaptation projects that would limit the impacts of climate change on health; to raise global awareness of the impacts of health from climate change at national and international levels; and to boost political attention and action. Member States also called on WHO to develop and strengthen the evidence base on links between climate change and health, and to help developing countries address health impacts from climate change.

The Health Assembly's actions were not limited to new challenges. Delegates also reaffirmed their commitments to eradicating polio and preparing for an influenza pandemic. Other actions included:

Female genital mutilation (FGM): Member States committed themselves to accelerating action towards the elimination of this practice through laws and educational and community efforts. Moreover, women and girls who have undergone FGM will be better supported, particularly as regards their care during childbirth, as well as in the social and psychological areas.

Global immunization strategy: Vaccines already prevent two to three million deaths a year but the Health Assembly noted that they are still underutilized. Delegates directed WHO to help countries reach higher immunization coverage and to encourage development of new vaccines.

Migrant health: Member States requested WHO to assess the health aspects in migrant environments and to explore options to improve the health of migrants.

"Health leaders from around the world have joined together in a united front on many big and difficult issues," said Dr Chan in closing the Health Assembly. "You consistently demonstrated a desire to reach consensus, and showed great flexibility in achieving compromise despite some significant differences."

All WHO media releases, fact sheets and features as well as other information on this subject are available on the WHO web site: www.who.int.

WHO 19 05 2008

WORLD HEALTH ASSEMBLY OPENS

amid tragedies, crises and opportunities

19 May 2008 GENEVA – As the 61st World Health Assembly opened today in Geneva, Switzerland, officials from 193 countries began the annual task of reviewing progress and setting new priorities for one of the most powerful tools in global public health, the World Health Organization (WHO). The event marks the 60th year of the international collaborative effort to relieve the burden of disease globally. But the mood of the anniversary meeting was sombre as the loss of life in the Myanmar cyclone and the China earthquake remained uncertain but certainly immense.

"We are meeting at a time of tragedy," WHO Director-General, Dr Margaret Chan, told the 2,500 delegates in the Assembly Hall of the Palais des Nations as she opened the meeting. "Unfortunately, looking ahead, we must all brace ourselves for more humanitarian crises in the immediate and near future."

Dr Chan provided the delegates with a stark survey of health challenges -- from ancient afflictions to future human health impacts of climate change. She reported on the mixed progress towards polio eradication and expressed the hope of overcoming the economic barriers that sometimes stand in the way of future public health achievements.

In the wake of recent disasters, Dr Chan looked ahead at three looming crises. Already apparent is a crisis of soaring food prices which could undermine the foundation of health and adequate nutrition. Climate change is a crisis on the horizon which is expected to bring more droughts, floods and tropical storms, and greater demands for humanitarian assistance. In both cases, the poor are at greatest risk. A third crisis, pandemic influenza, lurks in the future. Said Dr Chan: "The threat has by no means receded, and we would be very unwise to let down our guard or slacken our preparedness measures."

The existing list of health problems still press nations and strain resources:

While deaths from AIDS have declined in the last two years, a staggering 33.2 million people are living with HIV/AIDS, and 2.5 million were infected just last year. Said Dr Chan: "(W)e are still running behind this devastating, this unforgiving epidemic."

Tuberculosis control progress remains steady but multi-drug resistant TB has reached historic levels. Said Dr Chan: "To allow this form of TB to become widespread would be a setback, a setback of epic proportions."

Polio eradication efforts are also complicated. In Asia, polio type 1, the most dangerous strain, is on the verge of elimination. But in Africa, a "dramatic upsurge" in this strain has been seen in the northern states of Nigeria, while other countries in Africa are struggling to eliminate viruses reintroduced two years ago. Said Dr Chan: "(W)e must finish the job (of eradication): We are too close to allow success to slip through our fingers."

On the positive side, long struggles against many diseases are yielding results.

Malaria control is finally showing "solid progress," according to Dr Chan. Rapid improvements in morbidity and mortality have been documented in several African countries.

Immunization programmes have been able to drive childhood mortality below 10 million per year for the first time in recent decades.

Home-based treatment of pneumonia -- the number one killer of young children -- has been shown to be as effective, and possibly safer than hospital care, according to research coordinated by WHO published this year.

Big strides in global health can be made through control of the neglected tropical diseases. Safe and effective drugs have been identified to fight many of these diseases. These drugs are being donated through public-private partnerships or being sold at discount. Dr Chan noted that, with comparatively modest, time-limited funding, many of these diseases could be controlled, and some even eliminated, by 2015.

"Your guidance matters greatly, for health but also for our collective security," Dr Chan told the delegates. "Good health is a foundation for prosperity and contributes to stability, and these are assets in every country. A world that is out of balance in matters of health is neither stable nor secure."

19 May 2008 | GENEVA -- The global burden of disease is shifting from infectious diseases to noncommunicable diseases, with chronic conditions such as heart disease and stroke now being the chief causes of death globally, according to a new WHO report published today. The shifting health trends indicate that leading infectious diseases – diarrhoea, HIV, tuberculosis, neonatal infections and malaria – will become less important causes of death globally over the next 20 years.

World health statistics 2008 is based on data collected from WHO's 193 Member States. This annual report is the most authoritative reference for a set of 73 health indicators in countries around the world. These are the best available data and they are essential for painting the global picture of health and how it is changing.

“We are definitely seeing a trend towards fewer people dying of infectious diseases across the world,” said Dr Ties Boerma, Director of the WHO Department of Health Statistics and Informatics. “We tend to associate developing countries with infectious diseases, such as HIV/AIDS, tuberculosis and malaria. But in more and more countries the chief causes of death are noncommunicable diseases, such as heart disease and stroke.”

The statistical report documents in detail the levels of mortality in children and adults, patterns of morbidity and burden of disease, prevalence of risk factors such as smoking and alcohol consumption, use of health care, availability of health care workers, and health care financing. It also draws attention to important issues in global health, including:

Maternal mortality: in developed countries, nine mothers die for every 100 000 live births, while in developing countries the death rate is 450 and in sub-Saharan Africa it is 950.

Life expectancy trends in Europe: life expectancy in eastern Europe increased from an average of 64.2 years in 1950 to 67.8 years in 2005, representing an increase of only about four years compared with 9 to 15 years for the rest of Europe.

Health-care costs: 100 million people are impoverished every year by paying out of pocket for health care.

Coverage of key maternal, neonatal and child health interventions: four out of 10 women and children do not receive basic preventive and curative interventions and at current rates of progress it will take several decades before this gap is closed.

World health statistics 2008 is the official record of data produced by WHO’s technical programmes and regional offices in close consultation with countries and in collaboration with researchers and development agencies. In publishing these statistics, WHO underlines continuing health challenges and provides an evidence base for strategies to improve global public health.

25 April: GENEVA -- When millions of HIV-infected people in poor countries began receiving advanced drug therapies, critics worried that patient care would suffer because few high tech laboratories were available to guide treatments. But according to a study being published in Lancet Friday, 25 April, these concerns are as yet unfounded. In fact, the study indicates that when clinicians use simple physical signs of deteriorating health -- such as weight loss or fever -- these doctors can provide therapies almost as effective those relying on the most advanced laboratory analysis.

"The results of this study should reassure clinicians in Africa and Asia, who are treating literally millions of people without these laboratory tests, that they are not compromising patient safety," said a coauthor of the paper, Dr Charles Gilks, the Coordinator of Antiretroviral Treatment (ART) and HIV Care at the World Health Organization in Geneva. "In fact, the outcome of their treatment is almost as good as those patients in the USA and Europe where laboratory-guided treatment is the norm."

The aim of the study was to look at the medium and long-term consequences of different approaches to monitoring antiretroviral therapy in a resource limited setting: using clinical signs and symptoms alone as recommended in WHO guidelines; or more sophisticated and costly but far less accessible immunological and virological load tests. The scientists used a model that had been tried and tested in London, and shown accurately to predict the course of the epidemic in the UK over twenty years, but with various changes to reflect realities on the ground.

According to the study authors, survival rates for individuals assessed for clinical symptoms alone were almost identical to those who underwent laboratory monitoring. The 5-year survival rate was 83% for individuals monitored for viral load, 82% for CD4 (a critical immune component) monitoring, and 82% for clinical monitoring alone. Corresponding values over a 24-year period were 67%, 64% and 64% respectively.

Although the survival rate was slightly higher with viral load monitoring, study authors pointed out it was not the most cost-effective strategy in the poorest countries. The study also examined whether clinical observation alone was effective in determining when to switch patients from WHO-recommended first-line treatments to more costly second-line medicines. Again, diagnosis based on an assessment of clinical symptoms was almost as effective as those relying on expensive laboratory tests.

Study authors concluded that, for patients on the WHO first-line regimen of stavudine, lamivudine and nevirapine, the benefits of CD4 count or viral load monitoring were only modest at best.

The study, by a prominent group in the United Kingdom working with WHO scientists, employs mathematical models which were designed to identify emerging problems and problems that might appear after long term use of ART. But more work must be done. The study is based on mathematical projections and not on real world patients. While there is little real world data yet available, because these drugs have been used for such a short time in these countries, the little existing information does support the findings. Other studies are ongoing and more results should be available soon.

CLIMATE CHANGE WILL ERODE FOUNDATIONS OF HEALTH

7 APRIL 2008 | GENEVA -- Scientists tell us that the evidence the Earth is warming is "unequivocal." Increases in global average air and sea temperature, ice melting and rising global sea levels all help us understand and prepare for the coming challenges. In addition to these observed changes, climate-sensitive impacts on human health are occurring today. They are attacking the pillars of public health. And they are providing a glimpse of the challenges public health will have to confront on a large scale, WHO Director-General Dr Margaret Chan warned today on the occasion of World Health Day.

"The core concern is succinctly stated: climate change endangers human health," said Dr Chan. "The warming of the planet will be gradual, but the effects of extreme weather events -- more storms, floods, droughts and heat waves -- will be abrupt and acutely felt. Both trends can affect some of the most fundamental determinants of health: air, water, food, shelter and freedom from disease."

Human beings are already exposed to the effects of climate-sensitive diseases and these diseases today kill millions. They include malnutrition, which causes over 3.5 million deaths per year, diarrhoeal diseases, which kill over 1.8 million, and malaria, which kills almost 1 million.

Examples already provide us with images of the future:

European heat wave, 2003: Estimates suggest that approximately 70 000 more people died in that summer than would have been expected.

Rift Valley fever in Africa: Major outbreaks are usually associated with rains, which are expected to become more frequent as the climate changes.

Hurricane Katrina, 2005: More than 1 800 people died and thousands more were displaced. Additionally, health facilities throughout the region were destroyed critically affecting health infrastructure.

Malaria in the East African highlands: In the last 30 years, warmer temperatures have also created more favourable conditions for mosquito populations in the region and therefore for transmission of malaria.

Epidemics of cholera in Bangladesh: They are closely linked to flooding and unsafe water.

These trends and events cannot be attributed solely to climate change but they are the types of challenges we expect to become more frequent and intense with climate changes. They will further strain health resources that, in many regions, are already under severe stress.

"Although climate change is a global phenomenon, its consequences will not be evenly distributed," said Dr Chan. "In short, climate change can affect problems that are already huge, largely concentrated in the developing world, and difficult to control."

To address the health effects of climate change, WHO is coordinating and supporting research and assessment on the most effective measures to protect health from climate change, particularly for vulnerable populations such as women and children in developing countries, and is advising Member States on the necessary adaptive changes to their health systems to protect their populations.

WHO and its partners -- including the UN Environment Programme, the Food and Agriculture Organization, and the UN World Meteorological Organization -- are devising a workplan and research agenda to get better estimates of the scale and nature of health vulnerability and to identify strategies and tools for health protection. WHO recognizes the urgent need to support countries in devising ways to cope. Better systems for surveillance and forecasting, and stronger basic health services, can offer health protection. WHO will be working closely with its Member States in coming years to develop effective means of adapting to a changing climate and reducing its effects on human health.

"Through its own actions and its support to Member States," said Dr Chan, "WHO is committed to do everything it can to ensure all is done to protect human health from climate change."

The impact of climate change on human health

Statement by WHO Director-General Dr Margaret Chan

Last year marked a turning point in the debate on climate change. The scientific evidence continues to mount. The climate is changing, the effects are already being felt, and human activities are a principal cause.

In selecting climate change as the theme for this year’s World Health Day, WHO aims to turn the attention of policy-makers to some compelling evidence from the health sector. While the reality of climate change can no longer be doubted, the magnitude of consequences, and -- most especially for health -- can still be reduced. Consideration of the health impact of climate change can help political leaders move with appropriate urgency.

The warming of the planet will be gradual, but the effects of extreme weather events – more storms, floods, droughts and heatwaves – will be abrupt and acutely felt. Both trends can affect some of the most fundamental determinants of health: air, water, food, shelter, and freedom from disease.

Although climate change is a global phenomenon, its consequences will not be evenly distributed. Scientists agree that developing countries and small island nations will be the first and hardest hit.

WHO has identified five major health consequences of climate change.

First, the agricultural sector is extremely sensitive to climate variability. Rising temperatures and more frequent droughts and floods can compromise food security. Increases in malnutrition are expected to be especially severe in countries where large populations depend on rain-fed subsistence farming. Malnutrition, much of it caused by periodic droughts, is already responsible for an estimated 3.5 million deaths each year.

Second, more frequent extreme weather events mean more potential deaths and injuries caused by storms and floods. In addition, flooding can be followed by outbreaks of diseases, such as cholera, especially when water and sanitation services are damaged or destroyed. Storms and floods are already among the most frequent and deadly forms of natural disasters.

Third, both scarcities of water, which is essential for hygiene, and excess water due to more frequent and torrential rainfall will increase the burden of diarrhoeal disease, which is spread through contaminated food and water. Diarrhoeal disease is already the second leading infectious cause of childhood mortality and accounts for a total of approximately 1.8 million deaths each year.

Fourth, heatwaves, especially in urban “heat islands”, can directly increase morbidity and mortality, mainly in elderly people with cardiovascular or respiratory disease. Apart from heatwaves, higher temperatures can increase ground-level ozone and hasten the onset of the pollen season, contributing to asthma attacks.

Finally, changing temperatures and patterns of rainfall are expected to alter the geographical distribution of insect vectors that spread infectious diseases. Of these diseases, malaria and dengue are of greatest public health concern.

In short, climate change can affect problems that are already huge, largely concentrated in the developing world, and difficult to combat. On this World Health Day, I am announcing increased WHO efforts to respond to these challenges. WHO and its partners are devising a research agenda to get better estimates of the scale and nature of health vulnerability and to identify strategies and tools for health protection. WHO recognizes the urgent need to support countries in devising ways to cope. Better systems for surveillance and forecasting, and stronger basic health services, can offer health protection.

Citizens, too, need to be fully informed of the health issues. In the end, it is their concerns that can spur policy-makers to take the right actions, urgently.

10,000 HEALTH WORKERS STOP POLIO IN ONE OF THE MOST DANGEROUS PLACES ON EARTH

Somalia passes polio-free landmark

25 March 2008, Geneva, Switzerland – Somalia is again polio-free, the Global Polio Eradication Initiative (GPEI) announced today, calling it a 'historic achievement' in public health. Somalia has not reported a case since 25 March 2007, a major landmark in the intensified eradication effort launched last year to wipe out the disease in the remaining few strongholds.

Against a backdrop of widespread conflict, large population movements and a dearth of functioning government infrastructure, transmission of poliovirus in the country has been successfully stopped. This landmark victory is a result of the efforts of more than 10,000 Somali volunteers and health workers who repeatedly vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times, across a country ranked one of the most dangerous places on earth.

The use of innovative approaches tailored to conflict areas was pivotal in stopping polio in the country. These included increased community involvement and the effective use of monovalent vaccines to immunize children in insecure areas with several doses, within a short period of time.

"This truly historic achievement shows that polio can be eradicated everywhere, even in the most challenging and difficult settings," said Dr Hussein A Gezairy, Regional Director for the World Health Organization's Office for the Eastern Mediterranean.

Polio, which can cause lifelong paralysis, has been stopped nearly everywhere in the world following a 20-year concerted international effort. Only four polio-endemic countries remain – Afghanistan, India, Nigeria and Pakistan – and the eradication of polio globally now depends primarily on stopping the disease in these countries.

Poliovirus travels easily and, in the world of modern travel, can cover long distances. Until transmission of the virus has been interrupted in the four remaining endemic countries, the risk to the rest of the world remains high. Somalia, which had already eradicated the disease in 2002, became re-infected in 2005 by poliovirus originating in Nigeria. This repeated success in Somalia indicates the disease can be stopped even in areas with no functioning central government.

“Somalia beat polio in the midst of more widespread conflict and poverty than that affecting Afghanistan and Pakistan,” according to Dr Maritel Costales, Senior Health Advisor, UNICEF New York, citing insecurity and large population movements in those countries as challenges to reaching all children with vaccine. “But Somalia shows that when communities are engaged, children everywhere can be reached.” Afghanistan and Pakistan could be the first of the remaining endemic countries to stop polio; between them they account for 5% of all cases of polio in 2007.

Consistent financial commitment continues to be crucial to completing polio eradication. The global effort currently faces a shortage of US$525 million for 2008-2009, funding urgently needed to fight the disease in the remaining endemic areas and protect children in high-risk polio-free areas. Rotary International, the top private sector contributor and volunteer arm of the GPEI, has contributed US$9.2 million for polio eradication in Somalia, and US$700 million worldwide since 1985. “Somalia clearly shows that the tailored tools and tactics of the intensified eradication effort are working,” commented Mohamed Benmejdoub, Chair of Rotary's Eastern Mediterranean PolioPlus Committee. “A polio-free world is a feasible public health goal and a global public good. I urge governments across the world – and in particular the G8 countries – to rapidly make available the necessary resources. Together, we can ensure that no child need ever again suffer the terrible pain of lifelong polio-paralysis.”

Notes to editors:

The Global Polio Eradication Initiative is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988, the incidence of polio has been reduced by more than 99 percent. At the time, more than 350,000 children were paralysed every year, in more than 125 endemic countries. Today, four countries remain which have never stopped endemic transmission of polio: Afghanistan, India, Nigeria and Pakistan. In 2007, 1,308 cases have been reported worldwide (data as at 18 March 2008).

One of the 10,000 Somali volunteers and health workers is Ali Mao Moallim, who – more than 30 years ago on 26 October 1977 – became the last person on earth to contract smallpox. Over the past few years, working with WHO, he has travelled extensively throughout Somalia to immunize children against polio and foster community engagement during immunization campaigns. "Somalia was the last country with smallpox. I wanted to help ensure that we would not be the last place with polio, too," he stated.

Somalia's last case of indigenous polio was in 2002. On 12 July 2005, the country was re-infected by poliovirus originating in Nigeria, resulting in an outbreak of 228 cases in total. Systematic and wide-scale

WHO 17 03 08 FOR 24 03 2008

WORLD TB DAY 2008

WORLDWIDE EFFORTS TO CONFRONT TUBERCULOSIS ARE MAKING PROGRESS, BUT TOO SLOWLY

17 March 2008 -- Geneva -- The World Health Organization (WHO) report,Global Tuberculosis Control 2008, released today, finds that the pace of the progress to control the tuberculosis (TB) epidemic slowed slightly in 2006, the most recent year for which data were available. The new information documents a slowdown in progress on diagnosing people with TB. Between 2001 to 2005, the average rate at which new TB cases were detected was increasing by 6% per year; but between 2005 and 2006 that rate of increase was cut in half, to 3%.

The reason for this slowing of progress is that some national programmes that were making rapid strides during the last five years have been unable to continue at the same pace in 2006. Moreover, in most African countries there has been no increase in the detection of TB cases through national programmes. Other studies have also shown that many patients are treated by private care providers, and by non-governmental, faith-based and community organizations, thus escaping detection by the public programmes.

World TB Day (24 March each year), is observed around the world to build public awareness about tuberculosis. It commemorates the day in 1882 when Dr Robert Koch announced that he had discovered the cause of tuberculosis, the TB bacillus.